Active NPI
Kristen Lee Mauk, PHD, GNP-BC, GCNS-BC
- Gerontology Nurse Practitioner
- Valparaiso, IN
National Provider Identifier
1780994392
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Gerontology Nurse Practitioner
- License
- 28080868A
- Practice address
- 429 Oak Breeze Dr
Valparaiso, IN 46383-9319 - Phone
- (219) 531-2930
- NPI assigned
- Oct 15, 2010
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Gerontology Nurse Practitioner | 363LG0600X | 28080868A | IN | Primary |
| Adult Health Clinical Nurse Specialist | 364SA2200X | 28080868A | IN |
Addresses
Primary practice location
429 Oak Breeze Dr
Valparaiso, IN 46383-9319
Mailing address
429 Oak Breeze Dr
Valparaiso, IN 46383-9319
Phone (219) 531-2930
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner, Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 28080868A | IN | MD | Adult Health Clinical Nurse Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1287100800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1287100800000",
"number": "1780994392",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "429 OAK BREEZE DR",
"city": "VALPARAISO",
"state": "IN",
"postal_code": "463839319",
"telephone_number": "219-531-2930"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "429 OAK BREEZE DR",
"city": "VALPARAISO",
"state": "IN",
"postal_code": "463839319",
"telephone_number": "219-531-2930"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAUK",
"first_name": "KRISTEN",
"middle_name": "LEE",
"name_prefix": "Dr.",
"credential": "PHD, GNP-BC, GCNS-BC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-10-15",
"last_updated": "2010-10-15",
"status": "A"
},
"taxonomies": [
{
"code": "363LG0600X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Gerontology",
"state": "IN",
"license": "28080868A",
"primary": true
},
{
"code": "364SA2200X",
"taxonomy_group": "",
"desc": "Clinical Nurse Specialist, Adult Health",
"state": "IN",
"license": "28080868A",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Valparaiso, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.